powerpoint presentation: icd-10 faq review - georgia
TRANSCRIPT
December 17, 2013
ICD-10 FAQ Review
Presentation to: Providers, Trading Partners and Billing Firms Presented by: Camillia Harris, ICD-10 Communications Lead Erica Baker, ICD-10 Communications Consultant
Mission We will provide Georgians with access to
affordable, quality health care through effective planning, purchasing and oversight.
We are dedicated to A Healthy Georgia.
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Topics for Discussion
• ICD-10 Overview – ICD-10: It’s About Time – Why ICD-10 Matters
• ICD-10 Reminders • General ICD-10 FAQs • Clinical & Policy FAQs • Testing FAQs • Closing
– Helpful Resources
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ICD-10
Overview
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ICD-10: It’s About Time
ICD-10 is coming
October 1, 2014
Why is the transition necessary? - ICD-9 code sets are outdated, limited
and not expandable - ICD-9 cannot accommodate current
needs nor future advances in medical technology and knowledge
- ICD-10 code sets use current medical terminology and will allow for advances in medical technology and knowledge
- ICD-10 uses up to 7 characters (vs. 3 to 5 in ICD-9)
- ICD-10 allows for greater detail in diagnoses and treatments
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ICD-10 Facts
• For services rendered on or after October 1, 2014 – All claims must use ICD-10 codes – All claims using ICD-9 codes will NOT be accepted
• For services rendered before October 1, 2014 – All claims must use ICD-9 codes
• Systems must accommodate BOTH ICD-9 and ICD-10 codes – Effective with the October 1, 2014 compliance date
• Significant Code Increase from ICD-9 – Increasing from 13,000 to approximately 68,000 ICD-10-CM codes – Increasing from 3,000 to approximately 87,000 ICD-10-PCS codes – ICD-10 has more than nine times the codes in ICD-9
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Why ICD-10 Matters
• ICD-10 advances health care and the implementation of e-Health initiatives
• ICD-10 captures advances in medicine and medical technology
• ICD-10 improves data for quality reporting
• ICD-10 improves public health research, reporting and surveillance
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ICD-10 is Real
288 days until ICD-10 is here!
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ICD-10 Reminders
• Please keep the following in mind: – Transitioning to ICD-10 is not optional (firm and not subject to change) – There is no transition period to use either ICD-9 or ICD-10 codes
- If the date of service on a claim is before October 1, 2014, and contains ICD-9 codes, then the claim will be accepted for payment. If the date of service is after October 1, 2014, with ICD-9 codes, then this claim will be rejected.
– It is mandatory that you wait until October 1, 2014, to start using ICD-10 codes - Providers, trading partners, and clearinghouses will not be able to process claims
using ICD-10 codes until the compliance date of October 1, 2014.
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General
ICD-10 FAQs
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General ICD-10 FAQs Q: Where can we find a list of the new ICD-10 diagnosis codes? A: There are numerous resources available, but usually at a cost. The CMS website
offers a wealth of information on ICD-10 and the new codes. CMS has a General Equivalence Mapping (GEMs) tool that provides an ICD-10 diagnosis code to an ICD-9 diagnosis code. The GEMs tool is a basic tool and is not inclusive of all of the new ICD-10 codes.
Q: Does the new ICD-10 code change affect current Medicaid rates? A: No changes are anticipated at this time by Georgia Medicaid nor has CMS provided
any reimbursement rules or rate changes for the ICD-10-CM or ICD-10-PCS codes.
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General ICD-10 FAQs Q: Is there crosswalking software or some special algorithm available that we
can use to go from one code to the other? A: There are various websites and resources that offer a number of translation tools or
toolkits for ICD-10. Some are free; some are sold at varying prices. CMS has published its General Equivalence Mapping System (GEMS tool) to help with the crosswalking. It is available at www.CMS.gov/icd10. Note that this free tool is not comprehensive, but is frequently updated to add new codes. For more information on ICD-10, visit www.dch.ga.gov/ICD-10. For more information on tools, view the DCH ICD-10 webinar “Tools & Tips, Tackle the Transition to ICD-10,” (6/27/13) posted under Past Events at www.dch.georgia.gov/it-events.
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General ICD-10 FAQs Q: How do I learn more about ICD-10? A: Both the DCH and CMS websites contain a wealth of information about ICD-10. Visit
the DCH website for ICD-10 information, webinar events and more. Send questions to the DCH ICD-10 Team via e-mail at [email protected] and join our mailing list at [email protected] for the latest news about ICD-10 updates and events. Visit the CMS ICD-10 website for the latest news and resources to help you prepare for the October 1, 2014, deadline. You can also sign up for CMS ICD-10 Industry Email Updates.
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General ICD-10 FAQs Q: Will DCH do any ICD-10 training prior to October 1, 2014? A: No, DCH will not conduct any ICD-10 training. However, there are numerous
resources for self-development training on ICD-10. There are companies that may report their expertise of ICD-10 codes and offer training, but for a cost. Like any purchase of software applications, equipment, trainers, course materials, etc., evaluate the credibility of the product, the people/company and their purpose. DCH does not offer any recommendations of ICD-10 training companies.
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General ICD-10 FAQs Q: Will there be changes to ICD-9 codes for 2014? A: CMS is limiting the number of changes to the ICD-9 codes since the focus is now on
the ICD-10 codes. Q: Are there certain ICD-10 codes that Medicaid anticipates not accepting? A: There are some ICD-10 diagnosis codes that may not be accepted by Georgia
Medicaid, i.e., certain unspecified codes, when there is a more specific ICD-10 diagnosis code that can be billed. With the increased specificity and number of available ICD-10 codes, the physicians’ documentation would need to support the lowest level of ICD-10 coding.
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General ICD-10 FAQs Q: Does ICD-10 affect Orthodontics in anyway? If so How? A: All HIPAA entities such as health care providers, insurance companies and
governmental payers are required to accept and process claims using the new ICD-10-CM and ICD-10-PCS code sets. If your practice is currently submitting ICD-9-CM (diagnosis codes) on your dental claims, you will be affected with the transition to ICD-10 on October 1, 2014. It is strongly recommended that all affected health care providers begin their assessment and staff training for the transition.
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Clinical & Policy
FAQs
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Clinical & Policy FAQs Q: When will DCH publish coverage policy updates on ICD-10? A: All payers including DCH will publish their policies(for unlisted, unspecified, and
nonspecific codes) either prior to or after the ICD-10 go-live date of October 1, 2014.
Q: If we have a patient in the hospital on September 1, 2014, who does not
discharge until October 5, 2014 , will we need to include ICD-9 or ICD-10 codes on that claim? Will it need to be two separate claims?
A: You would submit ONE claim based on the patient’s discharge date. In the scenario above, the patient is discharged on October 5, 2014, the diagnosis codes on the UB-04 claim form must be ICD-10 diagnosis codes, otherwise the UB claim will be denied in GAMMIS.
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Testing FAQs
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ICD-10 Testing Reminders • Please keep the following in mind:
– DCH is nearing completion of our ICD-10 system enhancements for beta testing with our external partners.
– Due to the additional impact from the ICD-10-PCS codes, inpatient hospital claims may require additional internal testing time within DCH.
– DCH and HP Enterprise Services (our fiscal agent) are preparing additional security measures for assurance of protected health information. Additional information will be provided shortly.
– Beta testing will involve simulating an ICD-10 effective date which will be prior to the true effective date of October 1, 2014. This date will need to be coordinated with other testing that is occurring within our testing environment.
– We anticipate beta testing to begin late Q4 for Providers and early Q1 for Trading Partners/Clearinghouses/Billing Agents and Care Management Organizations.
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Testing FAQs Q: Will you allow for end-to-end testing with all providers and trading partners? A: No. We will only be testing with selected trading partners and providers. Q: Is it necessary for us to do beta-testing and if so, how do we do it? A: It is not a requirement to test with DCH. However, to determine your facility’s
readiness for the ICD-10 transition, it is highly recommended that you participate in testing with your trading partners and clearinghouse if possible.
Q: How do I sign up to become a beta testing partner with DCH? A: To become a Beta Test Site, please email your interest to:
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Testing FAQs Q: We sent in a request to become a beta tester but have not heard anything.
When will Georgia Medicaid announce the approved beta test providers? A: DCH has received a large number of beta tester requests and is currently finalizing
the list. Beta tester selections are based on multiple factors. Once the final list is confirmed, DCH will notify each requester.
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Testing FAQs Q: You indicated that testing will begin in December 2013 for providers and 2014
for clearinghouses. Is this for paper claims or just on the portal? A: Yes, testing will begin in December 2013 for some Providers and January in 2014
for some Trading Partners/Clearinghouses. Testing will not be conducted for paper claims. Testing will only be available for electronic submissions and web portal claims.
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Testing FAQs Q: As a third party billing company, will there be a testing period that allows us
to test the files submitted to ensure that those files are successful before actually having to submit and risk losing paid claims due to formats not working?
A: DCH is requesting billing agents who are interested in testing to send an email to [email protected] to notify us of your interest. We will not be able to test with all billing agents due to specific criteria. External testing will begin in Q1 2014 for Trading Partners/Clearinghouses/Billing Agents.
Resources
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CMS ICD-10 Checklists
• CMS has created ICD-10 Checklists to assist your organization in testing and overall ICD-10 compliance.
– Payer – Small Provider – Large Provider – Vendor to Provider – Vendor to Payer
Source: http://www.cms.gov/Regulations-and-Guidance/HIPAA-Administrative-Simplification/Affordable-Care-Act/End-to-End-Testing.html
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ICD-10 Training Resources
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ICD-10 Resources • Centers for Medicare & Medicaid Services (CMS) CMS Overview
- CMS ICD-10 Implementation Planning Guides/Checklist - HHS, CMS ICD-10 Final Rule - CMS, HHS Complete list of code sets for ICD-10-CM and ICD-10-PCS; Final
Rule and Official ICD-10-CM Guidelines – www.cms.hhs.gov/ICD10
• World Health Organization (WHO) ICD-10 Page – http://www.who.int/classifications/icd/en/
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More ICD-10 Resources
• DCH Resources – DCH Website for ICD-10 Webinars/Downloads http://dch.georgia.gov/it-events – DCH ICD-10 FAQs & Fact Sheet
http://dch.georgia.gov/icd-10
– DCH Provider Resources http://dch.georgia.gov/providers
• HP Enterprise Services Statewide Workshops – Check Georgia http://mmis.georgia.gov for future ICD-10 workshops
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Upcoming ICD-10 Webinars
Register Now December 17, 2013: ICD-10 FAQ Review January 16, 2014: “ICD-10: Ready or not”
January 30, 2014: Countdown to ICD-10/ Top 10 Things to do to prepare for ICD-10 February 11, 2014: ICD-10 Resource Review/ Resource Walkthrough reframed
February 27, 2014: HCBS Waiver ( Home and Community Based Service Providers) March 11, 2014: Behavioral Health Services …Open Discussion
March 27, 2014: ICD-10 Clinical and Policy Update April 8, 2014: Surviving ICD-10 - Tools and Tips for Transitioning
April 24, 2014: ICD-10 Case Studies June 10, 2014: Repeat Roadmap ICD-10 Emergency Tool Kit and Open Discussion
June 26, 2014: ICD-10 Essentials To register for the above webinars: Visit http://dch.georgia.gov/it-events
• Each webinar is scheduled for up to one hour, 10:30 – 11:30 a.m. ET. • Unless otherwise noted, all webinars are targeted to Providers and Trading Partners.
• Please be advised that webinar dates and times are subject to change.
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Thank You!
• Join us as an ICD-10 Beta Test Site, email us at: – [email protected]
• Join our mailing list at: – [email protected] for ICD-10 events and updates
• We welcome your questions and comments at:
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What about…? Use the WebEx Q&A Feature • Questions submitted will be
answered via email within 2-4 business days of this event
• Or you may email us at: [email protected] • This presentation will be posted
within 2 business days at http://dch.georgia.gov/it-events
Questions & Comments